January 31, 2006

There's John Roberts, chatting and laughing with Condoleezza Rice. On his other side is Clarence Thomas, then Stephen Breyer, who's looking happy if wizened, and he's next to Samuel Alito, who's looking truly vibrant. He must feel great. He's hanging out with Breyer. We see a close up of Alito, and he seems to be pulling in his smile, as if maybe it's in bad taste to over-beam right now. No Sandra Day O'Connor, unless she's stashed away somewhere else. No Scalia. No Souter. No Stevens. No Ruth Bader Ginsburg.

There's Laura in a pink suit.

Bush's first words are about Coretta Scott King.

He speaks of bipartisanship, and then confidence pursuing American interests, as opposed to timid withdrawal. "The only way to protect our people... is by our leadership." Bipartisanship, but we're not pulling out. "We seek the end of tyranny in our world."

"We will act boldly in freedom's cause... We're writing a new chapter in the history of self-government." Security demands freedom everywhere, including Iran.

Bush decries "radical Islam, the perversion by a few of a noble faith into an ideology of terror and death."

"The United States will not retreat from the world, and we will never surrender to evil." Applause. We see John Kerry giving a very quick standing ovation.

Progress in Iraq. Some grim faces in the audience, but there's Lieberman clapping. Bush looks happy, with a sneaking smile and crinkling eyes. "We are winning."

He accepts "responsible criticism": "Yet there is a difference between responsible criticism that aims for success, and defeatism that refuses to acknowledge anything but failure. Hindsight alone is not wisdom. And second-guessing is not a strategy." After he says that, there is applause and his face is set, then suddenly his jaw rotates in a truly bizarre way. What was that? What emotion, held in, burst out right there? He's pissed at his opponents! "A sudden withdrawal of our forces from Iraq would abandon our Iraqi allies to death and prison." The camera fixes on John Kerry, who's looking down, perhaps following the script, perhaps wondering when this part would finally be over. Anything domestic coming up? Because this is getting old.

He processes the disheartening news of the Palestinian election: "The Palestinian people have voted in elections – now the leaders of Hamas must recognize Israel, disarm, reject terrorism, and work for lasting peace." He sticks to his beliefs in democracy: "Yet liberty is the future of every nation in the Middle East, because liberty is the right and hope of all humanity." He speaks to the people of Iran: "Our Nation hopes one day to be the closest of friends with a free and democratic Iran."

He defends his surveillance program. After 9/11, there was criticism of failure to "connect the dots." "This terrorist surveillance program has helped prevent terrorist attacks. It remains essential to the security of America. If there are people inside our country who are talking with al-Qaida, we want to know about it – because we will not sit back and wait to be hit again." He says this last part with angry conviction. He is confident in this position, and I think this expression will be convincing to most listeners. There's a rousing standing ovation on one side of the aisle. On the other side, everyone's seated. We see Hillary Clinton, smiling quite brilliantly, but shaking her head in a Bush-is-wrong-as-usual way.

He's against "economic retreat." Being against retreat is the night's rhetorical device. His opponents, we're to think, want retreat.

"Make the tax cuts permanent." To let them end would be retreat, after all.

John McCain has been looking grim all night, but when Bush says "earmark reform" he beats his hands together wildly.

Is every female member of Congress wearing red? Nearly. Condi's in beige.

Crime... welfare.... drugs... abortion. Things are getting better: "These gains are evidence of a quiet transformation – a revolution of conscience, in which a rising generation is finding that a life of personal responsibility is a life of fulfillment." People need to be ethical, with some help from government, and correspondingly, government needs to be ethical: people are "concerned about unethical conduct by public officials, and discouraged by activist courts that try to redefine marriage." Wait! That's a strange linkage! Corrupt elected officials and "activist" courts? Courts finding too many rights aren't being immoral or unethical, though they are disappointing people with a conservative social agenda. These folks want moral elected officials. But those of us who favor strong judicial support for individual rights are also opposed to government corruption. It's a slap in the face to put these things in the same category.

"The Supreme Court now has two superb new members, Chief Justice John Roberts and Justice Sam Alito." We see each justice as he is named. Roberts has a clenched jaw and a downturned mouth that somehow reads as a proud smile. Alito has a similar serious face to start but then he breaks into a nice grin. Bush expresses thanks to Sandra Day O'Connor. But she's not there.

"Human life is a gift from our Creator," so don't mess with embryos. Interesting that this topic follows the part about the Supreme Court, isn't it?

Human beings determine the course of history. We have choices to make. "And so we move forward – optimistic about our country, faithful to its cause, and confident of victories to come."

A nice, vigorous speech. Full of optimism and courage. Ack! Now the NBC commentators come on and talk first about the "deep divisions" in the room. The Republicans applauded a lot more than the Democrats. Isn't that disturbing? "We just plain disagree on every fundamental issue that is confronting this country," Tim Russert says in a dire tone. What can Bush get done? Very little! Hey, forget your damned optimism and get depressed fast, people.

I am a bit disappointed he hasn't discussed how he plans to reform the White House itself. In the past year we've learned about Safavian, Scooter, Gannon/Guckert, Franklin/AIPAC, the Downing Street Memo. Speaking of spies like Franklin, there's Rove's outing of Valerie Plame. Yesterday Kenny Boy trial started. There was Heckuva Job Brownie and the cronyism at the White House that shows how unprepared FEMA and DHS is in protecting us. OBL is still out there and just gave George Bush a shout out last week. Zawahiri thumbed his nose at George Bush yesterday.

Yes, yes, it's been a heckuva year and a heckuva job done by The Chimpster.

Yes, he did say earlier this year that ID should be taught in schools. And his hamstringing of American researchers via the stem cell ban and funding cuts (meaning that the miracle cures will still be discovered, but they will be discovered elsewhere), and refusing to even look at global warming data makes me wonder how serious he is about science.

Medical malpractice reform? That's a winner that everyone will jump on board for.

Considering that the law prohibits people from suing their HMO for decisions denying coverage no matter what the consequences are, the problem is hardly that the health care system allows too much redress of grievances.

And speaking of malpractice, my own doctor has been sued once in 23 years. He won. The decision was that an aneurism was caused by something the guy who sued him had been born with and my doctor had nothing to do with it. But here's the rub: his malpractice premiums jumped through the roof simply because he had been sued. In simple terms, that was the insurance company making a ton of cash. So if there needs to be malpractice reform, it is not about limiting lawsuits, it is about reigning in the insurance companies.

But this is an ancillary issue anyway. In America, we spend 15.3% of our GDP on healthcare (2003 figure) while other countries, where the government negotiates with providers, spend around 9-12% of their GDP.

. But those of us who favor strong judicial support for individual rights are also opposed to government corruption. It's a slap in the face to put these things in the same category.

RIGHT ON, ANN!

And yes, things are getting better on abortion (down 33% since the early 1990's.) But 'abstinence only' education is such a recent phenomenon (and then limited to small areas) that it can't be credited. What can be credited is sex education, birth control (yes, condoms in the schools, which have been distributed for at least 15 years) and family planning. Not to Bush and Conservatives: Don't take credit for something that happened in spite of you, not because of you.

Crime also dropped by a huge amount in the 1990's after the 1993 Clinton crime bill that put 100,000 cops on the streets, built more prisons and spent money on youth programs (yes, midnight basketball worked, darn it). The crime rate quit going down by much about 2000, and it has hardly budged under Bush.

eli, I get sick when I hear about a cap of, what, $250,000? So if a doctor screws up and my son winds up paralyzed, that's what he'd get, to sustain him for the rest of his life? Do I understand the proposal?

eli, I get sick when I hear about a cap of, what, $250,000? So if a doctor screws up and my son winds up paralyzed, that's what he'd get, to sustain him for the rest of his life? Do I understand the proposal?

Wildabout, I am not a lawyer but I believe the cap you mention is on non-economic (pain and suffering) damages and that the anticipated cost of future medical care plus other damages could still be sued for.

He also talked about "zero emission coal plants". I thought he might have misspoke the word "low", but nope, it's in the prepared text.George, you can violate the constitution but you can't violate the laws of thermodynamics.I went to public school in Texas about the same time you did and they even taught that back then.

The problem though is this: If the doctor makes a mistake, even one resulting in say death of your child (like the case a couple of years ago when they put the wrong heart in a little girl at Duke Medical Center), you are limited to suing for $250,000. Frankly, there are some operations out there that can cost almost that much, so a $250,000 cap almost becomes like saying that if they kill your kid due to negligence or stupidity, then you get your money back.

That's interesting that the NBC commentators followed the President's speech, since the Democratic response by LA mayor Villaraigosa was scheduled to follow it.

Apparently the network is showing their conservative bias, covering the President's speech but pre-empting Villaraigosa so they can air some talking heads (and if they play Villaraigosa later it won't matter because people will respond like Ann and turn off the talking heads before they get a chance to watch the response.)

The $250,000 is worse than that. What it really does is make malpractice uninteresting to lawyers. At least in California what happens is that since the max award is $250,000 malpractice for things less than death or severe disfigurement or impairment are awarded much less than the $250,000.

My (now ex)wife was basically assaulted by a surgeon who was literally on a fishing expedition. Assault since no one ever agreed to the operation as it was performed and since there was no medical necessity for it. To make matters worse he last took an x-ray four weeks before the operation, he passed by taking an x-ray before the fishing expedition, and my wife's symptoms had changed in such a way as to alert other doctors that a new x-ray was needed.

Well apart from my wife being bedridden for about six weeks, and the loss of my pay for six weeks, and the loss of her ability to nurse our 3 month old at the time (she couldn't lift her up) and our outrage, there was no real visible damage.

So almost no one wanted to take the case. The lawyer that did, a professor who liked to take on such cases said that the max a win would get is would be $100,000. His fee would be $30,000, but as Ann can attest, that $30,000 is such a gamble to lawyers that it is hardly worth their effort.

So a bad surgeon gets away with assault. And that is really what the caps do, is they send the lawyers off to pursue more profitable work, like professoring.

I was glad when he offered American friendship to a future democratic Iran. I wanted to shake him silly during the opening ceremony of the last Olympics when the Iranian team came out and he looked like someone farted.

There was a tonal shift in this speech that was long overdue: rather than naming "bad" countries, he's saying countries under the bootheel of a-holes like Ahmadinejad, Mugabe, Kim Jong Il, etc. deserve better.

He accepts "responsible criticism": "Yet there is a difference between responsible criticism that aims for success, and defeatism that refuses to acknowledge anything but failure. Hindsight alone is not wisdom. And second-guessing is not a strategy.

Ann, so what do you think of Cindy Sheehan's arrest tonight for the crime of wearing a T Shirt to the Royal Ball?

"She was asked to cover it up. She did not," said Sgt. Kimberly Schneider, U.S. Capitol Police spokeswoman, adding that Sheehan was arrested for unlawful conduct, a misdemeanor.

The charge carries a maximum penalty of one year in jail, Schneider said.

Schneider said shortly after the State of the Union speech that Sheehan was still being held but should be "out sometime tonight."

An early report from a senior House official indicated that Sheehan was arrested for unfurling an anti-war banner, but that was later found not to be the case. Schneider said she didn't know what Sheehan's T-shirt said.

I am gratified to know that you favor strong judicial support for individual rights. So is this an example of First Amendment censorship?

NBC showed the Democratic Response, by the way. There was a gap between the two speeches. They have to at least give Bush the time to work his way through the crowd and out of the room. They even had time for some commercials. I do have th response on the TiVo though. I could watch it...

I'm inclined to agree. Why should doctors be able to escape liability for mistakes they make that cause serious harm? Conversly, why should people who are harmed by malpractice be forced to absorb those costs?

The problem is the insurance racket. The solution is taking health care out of the for-profit realm; viz -- single-payer health care.

Bad doctors, bad lawyers, bad engineers -- should all be tossed out of the profession. Kevin Drum discussed some studies showing, as you might expect, that it is just a few bad doctors that cause most of the problems over and over again, and yet they never have their licenses taken away.

Related: due to the first amendment, journalists are not considered professionals, and do not have professional organizations or policing of any sort. Which is one reason O'Lielly and the VWRC are able to so easily pervert journalism in the name of big bucks, and in the name of god.

Ann, are you a leader of the local bar? Do you actively police your profession?

his face is set, then suddenly his jaw rotates in a truly bizarre way. What was that?

Maybe there was an emotional component to the timing of it, but I think he just has TMJ -- temporomandibular joint syndrome. That could be caused by stress, tension, clenching his jaw or grinding his teeth in his sleep. I've noticed it before.

me - Human animal hybrids?? Did he get his cloning mixed up with his energy policy?That's really funny.

Meade - For example, an experiment that would raise concerns, he said, is genetically engineering mice to produce human sperm and eggs, then doing in vitro fertilization to produce a child whose parents are a pair of mice.

"Stuart Little" in reverse!

Ann: don't bother watching Kaine's response. It's lame. He has no charisma, is an inexperienced speaker, and the whole thing looks and sounds like an infomercial. Your heart will sink. Do you want that??

I don't know what the law is in CA, or exactly what is planned by the President as to medmal reform. But there are two sides to this debate, and you are only giving the one.

I know a bunch of docs, and, as an attorney, medical malpractice is always an issue when I am around them. I have one good friend who is an ER doc, and has a lot of "adverse outcomes" - a lot of people die in the ER. He gets sued a couple times a year, and has never lost. Nevertheless, he couldn't afford to practice if the hospital weren't covering him. Period.

The best surgeons do the most difficult work, have the most adverse outcomes, and are sued the most. But since they are the best, they don't lose either. It just makes them all that much more expensive.

Girlfriend is currently going through a lot worse situation that it appears your wife went through, both in number of surgeries and in total cost. It is PI, not medmal, but a lot of parallels apply. And yes, she could use the money for pain and suffering - she will be in pain for the rest of her life.

What most tort reform does is cap pain and suffering awards. Not economic loss. Not lost wages, medical costs, etc. But the nebulous pain and suffering that can easily turn a $100,000 case into a $10,000,000 case in front of the right jury.

And you gave away why pain and suffering is abused. It is what finances the lawsuits.

But where does that money come from? Ultimately, from everyone paying for health care, directly or indirectly, via their insurance premiums, paying significantly higher costs, or via taxes, such as for Medicare or Medicaid.

The other thing that is important to note here is that most statistics as to the cost of malpractice litigation are grossly inaccurate since they only take into account direct costs. What they ignore (IMHO intentionally) is that the fear of malpractice drives most docs today to order significantly more tests than are really needed. Many docs I talk to tell me (off the record, of course) that well over half the tests they order are not really necessary, but are ordered to CYA. This probably translates into a couple of percent of GDP a year, given how much is spent every year on health care.

We are at the point right now where we, as a society, cannot really afford to spend more, as a percentage of GDP, for health care. It is already above most, if not all, of the rest of the 1st World countries. On the other hand, there is a big push for (and I am sure, as a liberal, you are in favor of) health care coverage for all.

The only way to get more universal health care in this country is to get our medical costs under control, and the only way I can see that is to get malpractice costs under control, esp. the indirect costs, as noted above.

Unfortunately, we, as a society, have to make tradeoffs. And the tradeoff proposed is to ultimately trade pain and suffering awards for more universal healh care.

And, yes, I know there are butchers out there. And docs still don't police their own well enough yet. But the guys I know who have been sued dozens of times, and have never lost, are not butchers. They are extremely good physicians doing very difficult work well, and as a result, do have occasional adverse outcomes. (I am not saying that docs are any better, on average, than, say attorneys, just that due to the vaguaries of their practice, the most talented are doing the most difficult work, and are getting sued the most).

Bruce, I feel for good doctors, but there has to be a better way to deal with abuses than throwing out the baby. I don't understand why there aren't national licenses, for example - why can a doctor lose his license in one state for being a fraud, but practice in another one? And what about punishment for lawyers who bring frivilous claims, and judges who allow bloated awards?

Ann: government needs to be ethical: people are "concerned about unethical conduct by public officials, and discouraged by activist courts that try to redefine marriage." Wait! That's a strange linkage!

A judge who invents rights is unethical in the same way as a president who violates the constitution to enhance national security. Both believe they advance the public good, but they deny Americans the fundamental constitutional right to self-government.

"The road to hell ..." etc. etc. Personal venality isn't the only, or even the worst, kind of corruption.

Serenity Now - I see your point, but consider this: proposed Amendments that would ban gay marriage have gone nowhere. The Constitution wouldn't have been ratified without privacy guarantees and limitations on the Federal government's power to intrude on the lives of its citizens.

Draw your own conclusions, but I would suggest that at this pointin our history, boys kissing is the least of our problems.

One big problem, as I see it, is that PI/medmal pain and sufffering awards make this sort of litigation like playing the lottery. Most won't win, but those who do, win big. Sometimes, very big.

As for incompetent docs, etc., malpractice suits don't police them very well, since probably the bulk of the malpractice litigation is against very good docs in very dangerous specialties.

National licensing may make some sense. After all, it isn't like medicine differs from one location to another (supposedly like law does - though I was originally admitted to practice based on the national MBE alone).

Docs would probably resist this, but may ultimately buy in if they could get meaningful national med/mal reform in exchange.

Another aspect of medical costs is illegal immigration and the people who do not carry health insurance. They are treated for free, at least in CA hospitals, which has led to some closings of ERs. Since 2003 Medicare has "picked up" those costs that cannot be borne by states; however, Medicare is funded by taxpayers so the basic formula hasn't changed at all. My private health insurance gets more expensive every year to make up the difference between payers and non-payers, and I pay more taxes every year to fund the hospital bailout.